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ABSTRACT
Objective: To determine whether urine toxicology (Utox) screening, initiated by Neurology consultation, affects patient management.
Methods: A 5 year retrospective cohort, patients were included if Emergency Department (ED) Neurology consultation requested a Utox screen. Collected data included: demographics, chief complaint, patient disposition, length of stay, imaging performed, Utox results, final diagnosis, and re-presentation. Subgroup analyses on anti-epileptic drug (AED) therapy or stroke seen on magnetic resonance imaging (MRI) was also collected.
Results: Patients who had a Utox (n = 194) performed were an older mean age and more often male, otherwise demographics were similar to the ED population; seizure and altered mental status were the most common chief complaints. Prior polysubstance abuse and smoking were more common in Utox positive patients versus Utox negative (p-values<0.005). Comparing Utox negative and Utox positive cohorts, no statistically significant difference was seen for management outcomes (above). In seizure or altered mental status chief complaints (n = 106) subgroup analyses, 55.2% of Utox negative patients and 31.3% of Utox positive had an AED started or increased (p = 0.08).
Conclusions: Concrete end points for changes in management, based on Utox results, were unaffected. However, it does appear that Neurologists value Utox results in seizure management.
Disclosure of potential conflicts of interest
Both Drs. Kase and Perloff have consulted outside of Boston University, but no potential conflict of interest for the subject matter at hand is perceived. Drs. Blattner and Spengler have no disclosures.
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Notes on contributors
Michael D. Perloff
All authors, study concept and design, Matthew Blattner, Danielle Spengler and Michael Perloff, acquisition of data
Matthew R. Blattner
Michael Perloff and Carlos S Kase, analysis and interpretation of data
Danielle C. Spengler
Michael Perloff, study supervision
Carlos S. Kase
Michael Perloff and Carlos S Kase, critical revision of manuscript for intellectual content